This paper provides an overview of United States-based research on the ways in which racism can affect mental health. It describes changes in racial attitudes over time, the persistence of negative racial stereotypes and the ways in which negative beliefs were incorporated into societal policies and institutions. It then reviews the available scientific evidence that suggests that racism can adversely affect mental health status in at least three ways. First, racism in societal institutions can lead to truncated socioeconomic mobility, differential access to desirable resources, and poor living conditions that can adversely affect mental health. Second, experiences of discrimination can induce physiological and psychological reactions that can lead to adverse changes in mental health status. Third, in race-conscious societies, the acceptance of negative cultural stereotypes can lead to unfavorable self-evaluations that have deleterious effects on psychological well-being. Research directions are outlined.
Background. Subjective accounts of health status are increasingly utilized in social surveys and medical research to assess functioning and well-being. Despite the fact that substantial research evidence suggests that self-rated health is meaningful and provides valid and reliable data, some authors have raised concerns that different social groups may interpret the notion of health in different ways, and hence complete health measures in systematically different ways. This study evaluates the validity of using self-rated health status to measure health status in different ethnic groups. Methods. Logistic regression models were used to examine the association of selfrated health with more objective measures of morbidity in different ethnic groups. Sample. Two sources of data were used-the Health Survey for England (HSE) 1991-96 combined file and the Fourth National Survey of Ethnic Minorities (Ethmins4). Measures of health. Hypertension, presence of cardiovascular disease or diabetes, limiting health and number of visits to a doctor. Self-rated health was measured on 5-point scale ranging from excellent to very poor. Results. Poorer self-rated health was associated with greater morbidity within each ethnic group. Furthermore, there was little evidence that the association of self-rated health with more objective measures of morbidity differed between ethnic groups. Conclusion. The evidence reported here suggests that the use of a single item measure of self-rated health to measure health status in different ethnic groups is valid. Further research might usefully explore the validity of using more comprehensive profile measures of health status in different ethnic groups.
Objective. The purpose of this study was to assess grade, race, socioeconomic status and gender differences in perceptions of body size, weight concerns, and weight control practices between 4th and 7th grade students in South Carolina. Design. Two random samples, consisting of a total of 1,597 children (53.1% white, 51.97% female, 44.9% 4th graders) participated in two questionnaire surveys. Both surveys included a series of seven female and seven male body size drawings, body image and weight concern questions, and questions pertaining to weight control practices. Responses to the questionnaire were analyzed using chi-square analysis and the General Linear Model. Results. Using socioeconomic status (SES), race, gender, and grade as independent variables, differences in ideal adult body size, opposite gender ideal adult body size, weight concerns, perceptions of family/peer weight concerns, perceptions of own body size and weight control practices were studied. Analyses revealed that 4th grade males select a larger ideal adult body size and opposite gender ideal adult body size when compared to 7th grade males ( p < 0.0001 and p = 0.0078, respectively). Fourth grade females indicated less personal concern about their weight than 7th grade females ( p = 0.0009). Fourth graders also perceived less family/peer concern about weight than 7th graders ( p = 0.0027) and 7th graders described themselves as being more overweight than 4th graders ( p = 0.0039). Blacks selected a significantly larger body size than white children for ideal adult ( p = 0.0287) and ideal opposite gender adult body size ( p < 0.0001 for males, p = 0.0030 for females). Blacks also perceived less personal and family/peer concern about weight when compared to whites ( p = 0.0083). More whites reported that they were trying to lose weight, as compared to blacks ( p = 0.0010). Males also selected significantly larger body size silhouettes than females for ideal adult body size ( p = 0.0012). Males expressed less personal concern about weight ( p < 0.0001), perceived less family/peer concern about weight ( p < 0.0001), and were less likely than females to be engaged in weight loss ( p < 0.0001). Females in the high SES category selected a significantly smaller ideal male adult body size than females in the low SES group ( p = 0.0124) and more females in the high SES category were trying to lose weight when compared to females in the low SES group ( p = 0.0055).) Conclusion. This study indicates that early in a child's sociocultural development, grade level, gender, race, and SES are influential in the perception of ideal adult body size and opposite gender ideal adult body size. These factors are also influential in determining concerns about weight and weight control practices. The findings of this study support the need to begin health and wellness education efforts early in childhood while taking into account racial, gender, age, and SES disparities. This knowledge can also be useful in targeting interventions for both obesity and eating disorders.
We undertook a retrospective analysis of the prevalence of obstetric cholestasis in the population of the South Birmingham area in the various ethnic subgroups. A diagnosis of intrahepatic cholestasis of pregnancy was made on the basis of symptoms of generalised pruritis along with biochemical evidence of the condition, after ruling out other liver diseases. We found an overall prevalence of 0.7%, with an occurrence in the white population of 0.62%, compared to that in the Asians of Pakistani origin of 1.46%. In the Asians of Indian origin it was found to be 1.24%. The prevalence of obstetric cholestasis was significantly higher in the Pakistani and Indian subgroups compared to the whites.
Objective. We examined adverse birth outcomes among Mexican-Americans to determine the effect of country of maternal birth, a measure of acculturation. Design. We conducted a retrospective cohort analysis of birth outcomes among 4800 Mexico-born and 4800 US-born Mexican-American women using Washington State birth certificate data from 1989 to 1994. Length of residence at current address was used to help refine our measure of acculturation. Results. US-born women had a slightly increased risk of preterm birth relative to Mexico-born women [relative risk (RR) 1.18, 95% confidence interval (CI) 1.04-1.33]. Among Mexico-born women, the risk of preterm birth increased with greater duration of current residence. Conclusions. US-born Mexican-American women had a slightly increased risk of preterm birth despite having more adequate prenatal care, more education, and higher socioeconomic indicators. This may be due to acculturation factors, such as earlier pregnancy, loss of social support systems, and increased smoking or alcohol use. Reducing this risk depends on recognition among health care workers and policy-makers of the potential influence of acculturation on health in this population .
Objectives. This study examines the relatively low use of modern pregnancy-related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in care. Methods. The data for the analysis come from the Guatemalan Survey of Family Healtha population-based survey of rural women that contains detailed data on care received during pregnancy and delivery along with extensive background information. Binomial and multinomial logit models are used to identify the variables that affect the likelihood of receiving different types of care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the observed ethnic differences. Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend them by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly associated with modern pregnancy-related care than are measures of access and that the former variables explain more of the ethnic variation in care than the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction with traditional midwifery care rather than to rely solely on the former. Conclusion. The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to modern health facilities improves. Current efforts directed toward the training and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replacement of midwives with biomedical providers.,Objectives. This study examines the relatively low use of modern pregnancy-related care in Guatemala, especially among indigenous women, and explores the role of socioeconomic status, social and cultural variables, and access to biomedical health facilities in accounting for ethnic differences in care. Methods. The data for the analysis come from the Guatemalan Survey of Family Health-a population-based survey of rural women that contains detailed data on care received during pregnancy and delivery along with extensive background information. Binomial and multinomial logit models are used to identify the variables that affect the likelihood of receiving different types of care during pregnancy and delivering in a medical facility and the extent to which sociocultural factors and measures of access account for the observed ethnic differences. Results: The estimates not only confirm previous findings of a large ethnic difference in the use of modern pregnancy-related care, but also extend them by identifying a gradient within the indigenous population. The analysis demonstrates that, in general, sociocultural variables are more strongly associated with modern pregnancy-related care than are measures of access and that the former variables explain more of the ethnic variation in care than the latter. The results also demonstrate that pregnant women, especially indigenous women, are more likely to seek biomedical care in conjunction with traditional midwifery care rather than to rely solely on the former. Conclusion. The findings suggest that midwives are likely to continue to be key providers of pregnancy-related care in the future, even as access to modern health facilities improves. Current efforts directed toward the training and integration of midwives into the formal health system are likely to be much more effective at improving pregnancy-related care than the replacement of midwives with biomedical providers.
There is a need for a valid way to classify the human species consistently and reliably, be it to highlight similarities between human populations such as intelligence or physical capacity, to dispel myths about group differences, or to discover 'novel' risk factors for diseases. In contrast to racial divisions, which are usually based on differences in skin colour and physical features, ethnicity is a complex concept which has both socio-cultural and biological components. However, because of the relative vagueness of the term, the interpretation of the 'Ethnicity' construct is not simple, and its definition is often unique to the research project at hand. Therefore conducting ethnicity-research necessitates being aware of the differences between the concept of ethnicity and race, acknowledgement of the complexity of the ethnicity construct, and requires that a clear definition of the use of this term be made explicit by the researcher.
Background. Prevalence of type 2 or non insulin dependent diabetes mellitus is high among Indians living in India as well as abroad. Prevalence among persons of Indian origin in many countries is greater than that of people of other ethnic extraction. The Indian state of Kerala is distinguished by a high level of achievement in the health sector, characterised by both lower mortality rates and greater density of health care institutions that ensure access to most people. These attributes make the prevalence of diabetes and the pattern of its management in Kerala worth studying. Objective. To estimate the prevalence of diabetes among persons 20 years or older in an urban housing settlement in Trivandrum city, the capital of Kerala, as well as study the management of the disease in subjects affected. Design. Cross sectional survey for detecting diabetes and other chronic diseases in all willing residents of an urban housing settlement in Trivandrum, the capital city of Kerala, as part of a preventive campaign against lifestyle diseases. Fasting plasma glucose, serum triglycerides, cholesterol, height, weight and blood pressure were measured, and a detailed questionnaire administered to ascertain previous diabetic status and management. Results. Overall prevalence of type 2 diabetes is 16.3%. In the 30-64 age group, age standardised prevalence is 13.7%. Gender differences in prevalence are negligible. Greater prevalence is associated with advancing age, body mass index above 24.99, sedentary habits, serum total cholesterol > 239, serum triglycerides > 149, hypertension and smoking. Compared to non-diabetics, diabetics have greater mean and range of fasting plasma glucose values (8.87 + /-3.6 mM/l as against 4.34 + /-0.53 mM/l). 32 out of 38 diabetics among the subjects (82.4%) were already diagnosed even before the survey; of them, 89% were on medication. 3% of subjects had impaired fasting glucose, or FPG level between 110-125 mg/dl. Conclusion. Prevalence of type 2 diabetes among a group of urban residents in Trivandrum city in Kerala is very high. This is associated also with a high detection rate and compliance to treatment.
Objectives. To study the social contexts and physiological consequences of an initial cigarette smoking experience among adolescents from four ethnic groups (African American, European American, Hispanic, Native American) who vary by gender and locale (e.g. urban vs rural). Method. A qualitative study using individual interviews and focus groups. Results. Results both amplify and reinforce conclusions about peer and family influences on adolescent smoking initiation reported in quantitative studies of teen smoking. Within the broader themes of peers and family, several important sub-themes emerged. The study findings suggest that peer influence can be characterized as social conformity or social acceptance. Males were more likely than females to describe experiences involving peers exerting strong messages to conform to smoking behaviors. Roles played by family members in the initiation process were complex and included those of initiator, prompter, accomplice, and inadvertent source of cigarettes. European American and Hispanic girls provided descriptions of parents/family members as instigators of their first smoking experience. Hispanic adolescents descripted instances in which family members prompted cigarette use at a young age by encouraging the young person to light the adult's cigarette. Finally, ethnic differences in the physiological responses to initial smoking suggest the need to further explore the role of brand preference and variations in inhaling among ethnically diverse adolescents. Conclusion. In order to design effective cigarette smoking prevention programs for adolescents, it is important to understand the meaning of smoking behaviors for adolescents from different ethnic and social backgrounds.
Objective. To describe access to dental care in a population-based sample of foreignborn Swedish residents in relation to dental health. Design. The study was based on data from the Immigrant Survey of Living Conditions in four minority study groups consisting of a total of 1,898 Swedish residents born in Poland, Chile, Turkey and Iran aged 2760. An age-matched study group of 2,477 Swedish-born residents from the Survey of Living Conditions of 1996 was added as a comparison group. The study also included 2,228 children aged 315 years in the minority households and 2,892 children in the households of the Swedish-born study group. Results. The risk of poor dental health was higher in all four minority study groups than for the Swedish-born study group after adjusting for socio-economic variables. In the adult minority study groups the adjusted odds ratios (ORs) for having prostheses and problems with chewing was 6.3 (4.39.1) and 2.7 (1.84.3), respectively, for the Polish-born, 4.8 (3.37.1) and 3.2 (2.14.9) for the Chilean-born, 4.6 (3.16.9) and 4.8 (3.67.2) for the Turkish-born, and 2.7 (1.54.8) and 6.5 (4.110.3) for the Iranian-born compared with the Swedish-born. In the child study group all four minority groups had an increased risk of caries ranging from OR 1.6 (1.32.1) in the Chilean group to 2.5 (2.03.0) in the Turkish group compared with the children with Swedish-born parents. The adults in all four minority study groups more often lacked regular treatment by a dentist than Swedish-born residents. The OR for not having been treated by a dentist during the 2 years preceding the interview ranged from 1.9 (1.42.6) in the Polish-born study group to 3.0 (2.34.0) in the Chilean-born study group after adjustment for socio-economic factors and general health. Conclusion. This study demonstrates that adults in minority populations in Sweden use less dental care despite having greater needs of dental treatment than the majority population. This inequity calls for action in health policy and preventive dental health programmes.,Objective. To describe access to dental care in a population-based sample of foreignborn Swedish residents in relation to dental health. Design. The study was based on data from the Immigrant Survey of Living Conditions in four minority study groups consisting of a total of 1,898 Swedish residents born in Poland, Chile, Turkey and Iran aged 27-60. An age-matched study group of 2,477 Swedish-born residents from the Survey of Living Conditions of 1996 was added as a comparison group. The study also included 2,228 children aged 3-15 years in the minority households and 2,892 children in the households of the Swedish-born study group. Results. The risk of poor dental health was higher in all four minority study groups than for the Swedish-born study group after adjusting for socio-economic variables. In the adult minority study groups the adjusted odds ratios (ORs) for having prostheses and problems with chewing was 6.3 (4.3-9.1) and 2.7 (1.8-4.3), respectively, for the Polish-born, 4.8 (3.3-7.1) and 3.2 (2.1-4.9) for the Chilean-born, 4.6 (3.1-6.9) and 4.8 (3.6-7.2) for the Turkish-born, and 2.7 (1.5-4.8) and 6.5 (4.1-10.3) for the Iranian-born compared with the Swedish-born. In the child study group all four minority groups had an increased risk of caries ranging from OR 1.6 (1.3-2.1) in the Chilean group to 2.5 (2.0-3.0) in the Turkish group compared with the children with Swedish-born parents. The adults in all four minority study groups more often lacked regular treatment by a dentist than Swedish-born residents. The OR for not having been treated by a dentist during the 2 years preceding the interview ranged from 1.9 (1.4-2.6) in the Polish-born study group to 3.0 (2.3-4.0) in the Chilean-born study group after adjustment for socio-economic factors and general health. Conclusion. This study demonstrates that adults in minority populations in Sweden use less dental care despite having greater needs of dental treatment than the majority population. This inequity calls for action in health policy and preventive dental health programmes.
Objectives. To examine the incidence of cancers among persons born in Scotland, Northern Ireland, the Irish Republic, Caribbean Commonwealth and Indian subcontinent and living in England and Wales. Methods. Longitudinal Study of 1% of population of England and Wales followed from 1971 to 1989. Standardised incidence ratios (SIRs) were derived for commonly occurring cancers and all cancers using the age-sex-specific rates for all females and all males in the Longitudinal Study. Results. The incidence of all malignant neoplasms among West Indians (females SIR = 67, male SIR = 70) and Indians (female SIR = 32, male SIR = 52) was low. Among South Asians, this pattern was consistent for Hindus, Sikhs and Moslems. Scottish females showed raised incidence of lung cancer (SIR = 149) and those from the Irish Republic of oral cavity and pharynx (SIR = 321), oesophageal (SIR = 219) and liver (SIR = 373) cancers. Among Northern Irish females, incidence of lung cancer (SIR = 193) was raised. West Indian and South Asian females showed low incidence of breast cancer (SIR = 55 and 45, respectively). High incidence of laryngeal (SIR = 229) and renal (SIR = 203) cancers was observed for Scottish males and of oral cancer (SIR = 259) for males from the Irish Republic. At ages 15-64, raised incidence of prostate cancer (SIR = 129) and of leukaemia (SIR = 252) was also observed for men from the Irish Republic. Northern Irish males showed raised incidence of stomach cancer (SIR = 200). Conclusion. This study describes patterns of cancer incidence among migrant groups, most of which reflect environmental influences. This has challenging implications for sensitive targeting of primary interventions. It is important not to be complacent about lower risks of main cancers among West Indians and South Asians. In all Longitudinal Study members, breast cancer was the most common malignancy among females and lung cancer among males. This was also true for all migrant groups with the exception of Northern Irish women for whom lung cancer was the most common.
The Truth and Reconciliation Commission (TRC) has been widely hailed by mental health practitioners and others as a source of psychological healing. In this article we consider this claim and its relevance to clinical practice. Recent research in anthropology and related disciplines in South Africa and elsewhere raises questions about the cultural construction of traumatic memory and healing. We argue that these questions have bearing on how we understand the role of mental health practitioners and mental health institutions in the post-TRC period. Case material is be used to illustrate our view that it is important to distinguish between individual and collective healing.
Objectives. To apply the Transtheoretical Model of Behaviour Change (TTM) to cervical cancer screening to determine and report on the level of support required by different language and cultural groups in Queensland to enhance participation. The model consists of six stages: Pre-contemplation (no intention to be screened, no past action), Contemplation (intention to be screened, no past action), Action (intention to be screened, initial screening), Maintenance (intention to be screened, regular screening), Relapse (no intention to be screened, initial screening) and Relapse Risk (no intention to be screened, regular screening). Design. Focus groups and structured interviews were used to classify women in terms of the model and collect information regarding knowledge, health service contact barriers and enhancing factors and sources of information in relation to cervical cancer screening. The sample was recruited by bi-cultural workers for each community using snowball techniques. Results. The interview sample consisted of Australian South Sea Islanders, Chinese, German, Greek and Moslem women. There was no evidence of significant differences in TTM stage according to ethnicity. Women who intended to be screened in the future were more likely to have positive decisional balance scores and higher knowledge scores than women who did not. Women who had had Pap tests were significantly more likely to have received information from their general practitioner (GP) than women who had not had Pap tests. Women in Action and Maintenance were also more likely to have had their last Pap test by a female GP compared to women in relapse categories. Women in Pre-contemplation were more likely than women who had Pap tests to agree that they would travel a long way to see a practitioner who spoke their own language. Conclusion. Classification based on the model was supported both by the decisional balance scale and measures of knowledge. Women in earlier stages of the model were more likely to express preferences for the provision of services in their own language and by a female. Cervical cancer screening among women in Action and Maintenance appeared to be better supported by GPs. Cervical cancer screening promotion for women of diverse cultures and ethnicities has tended to focus on Pre-contemplation and Contemplation stages, however, as most women in this sample were in Action or Maintenance, as are most Australian-born women, structuring cervical cancer screening promotion in terms of the TTM may significantly improve the effectiveness of interventions for women of diverse cultures and ethnicities.
Objective. To increase the uptake of breast screening in three inner city GP practices with a high proportion of ethnic minority patients . Setting. The study was carried out in May and June 1997 in the South East Wales division of Breast Test Wales (BTW). Three inner city general practices in Cardiff, with a low uptake in the previous round of breast screening and a high proportion of ethnic minority women on their lists, were targeted to receive interventions to increase uptake. This preliminary study was not randomized but sought to offer insights into the interventions which may be worth pursuing and the groups that are harder to reach. Design. Interventions: identification of ethnic language groups; GP endorsement letter; translated literature including: multilingual leaflet, GP letter, screening invitation; transport to the screening centre; language support. Results. Of 369 women invited, 187 attended for screening. This gives an uptake of 50.7% compared with an uptake of 35.2% in the previous screening round, a statistically significant increase of 15.5%. (95% CI + 8.2% to + 22.5%). Conclusion. Findings show that translated literature, GP endorsement letter and language support by linkworkers were beneficial. The provision of free transport was ineffective and under-utilized. Uptake was highest amongst Urdu and Gujarati speaking groups and lowest for Bengali and Somali speakers which are hardest to reach. There is scope for improving the attendance rate amongst ethnic minority groups but this can prove costly.
This paper examines the adverse situation that continues to face South African children. Children have until very recently, been regarded as one of the most neglected and overtly oppressed sectors of South African society. The installation of a democratic government ushered in a range of policies and measures designed to promote the wellbeing of children. Despite this new commitment and support, the position of children has remained one of considerable concern. In this paper we report on a range of social, educational, health and psychological indicators of the wellbeing of South African children both before and after the 1994 elections. Although there is a dearth of systematic and national data-bases, a growing number of research and other reports indicate that the country remains a challenging and at times hostile context for its children. As the country proceeds with its reconstruction and development programme, the urgent need for social and psychological services for children remains a particular concern .
Objective. To find out the degree of life satisfaction among adolescents with immigrant background, and the factors that may predict the level of life satisfaction among them. Method. Five hundred and six adolescents (mean age = 15.34, SD = 7.67) with immigrant background from Vietnam, Pakistan, Chile and Turkey were recruited from five major Norwegian cities, and were asked to fill in a questionnaire with several measures, including demographic information, life satisfaction, acculturation strategies, ethnic identity and mastery. A control group invoving 209 Norwegian youth were also included in the study. Results. On the whole the adolescents with immigrant background were found to be fairly satisfied with their life (M. = 3.55, SD = 0.81). Using Socio-Economic Status as covariance, adolescents with immigrant background did not differ from their Norwegian counterparts on life satisfaction level (F = 0.58, p > 0.05). Chileans were found to be the most satisfied group, and Vietnamese the least satisfied. The higher life satisfaction among Chileans compared with the other ethnic groups is viewed as a possible selection bias. While demographic factors accounted for just 4% of the explained variance, personal factors accounted for over 20% of the explained variance. Mastery (ß = 0.39) and ethnic identity (ß = 0.17) were the two most important predictors of life satisfaction. Living in an ethnically homogenous neighbourhood was also found to be related to life satsifaction. Perceived discrimination and integration as an acculturation strategy were not related to life satisfaction. Conclusion. The study concludes that helping adolescents with immigrant background to develop a good sense of mastery and a positive ethnic identity will go a long way to boost their life satisfaction.
Objective. The knowledge of elderly migrants' health, particularly those who are retired or in transition to retirement is limited. The purpose of this study was to analyse the association between migration, socio-economic status (SES), and risk factors for cardiovascular disease (CVD). Design. A simple random sample of 253 foreign-born persons and 2847 Swedish-born persons aged 55-74 were drawn from the Swedish Population Registry. They were interviewed by Statistics Sweden in 1988-89. Outcome variables were leisure-time physical inactivity, smoker/non-smoker status, body mass index (BMI), hypertension, and diabetes mellitus. Explanatory variables were sex, age, marital status, migration status (country of birth), and SES (income). Logistic and linear regression were used. Results. Elderly foreign-born people ran an increased risk of engaging in no physical activity (men only), being a current smoker, and having an increased BMI after adjustment for background factors. In addition, a low income (first tertile) was an independent risk factor for physical inactivity (men only), as was being a current smoker (men only), BMI, hypertension, and diabetes mellitus. Thus, the burden of being an elderly migrant increases the risk of a disadvantaged lifestyle between 50 and 80% compared with Swedes. Conclusions. This study shows that migrants who are retired or in transition to retirement have a disadvantaged risk profile for cardiovascular disease. It might be possible to improve this situation by intervention, as for example by increasing a person's interest in walking.
As part of a wider investigation of cross-cultural communication practices in health care and social service institutions of Vienna, a survey among hospital staff was conducted to establish the need for mediated communication between service providers and non-German-speaking patients. The responses of 508 doctors, nurses and therapists demonstrate a substantial need for interpreting services, which is currently met by family members (most often children) and bilingual hospital employees (most often cleaners). Most of the respondents were well aware of the shortcomings of ad hoc interpreting arrangements and voiced a clear preference and demand for a hospital interpreting service to improve communication with and health care provision to non-German-speaking patients.
Objectives. To describe the pattern of complaints and complications in pregnancy among ethnic Norwegian and ethnic Pakistani women in Oslo in order to modify antenatal care services. Design. A cross-sectional study of hospital patients conducted in community hospitals in Oslo, Norway. A total of 137 obstetrical patients, 66 ethnic Pakistani and 71 ethnic Norwegian women were included in the study. Medical complications and subjective reported physical complaints during pregnancy were the main outcome measures. Results. Among the ethnic Pakistani women complications were more common and the risks were higher for gestational diabetes (crude odds ratio (OR) = 5.6, 95% confidence interval (CI) = 1.5-20.5), intrauterine growth retardation (crude OR = 5.0, 95% CI = 1.4-18.8), hyperemesis gravidarum (crude OR = 3.7, 95% CI = 1.1-12.2) and anaemia (crude OR = 10.2, 95% CI = 3.3-31.4). The frequency of congenital malformations (p = 0.048, OR not calculated) were also higher. Among the ethnic Norwegian women the frequency of subjective reported physical complaints were more common and the risks were higher for pelvic girdle pain (crude OR = 0.4, 95% CI = 0.2-0.8) and exhaustion (crude OR = 0.2, 95% CI = 0.04-0.1). Infections such as hepatitis and tuberculosis only occurred in the Pakistani study group. Conclusion. This study indicates that health personnel delivering antenatal care to women of Pakistani origin need to be watchful for the following conditions: gestational diabetes, hyperemesis gravidarum, early diagnosis of the type of anaemia, fetal malformations and infections like hepatitis and tuberculosis. In addition, a correct diagnosis of intrauterine growth retardation is important. Among ethnic Norwegian women pelvic girdle pain and exhaustion were common complaints .
This paper explores the competing and often diverging psychological needs of the individual and the society with regards to making reparations for gross violations of human rights. The South African Truth and Reconciliation Commission's mandate and policy recommendations with regards to reparations for survivors and families of victims of human rights abuses are outlined. Thereafter, some of the psychological benefits and double-binds of making reparations are explored. Suggestions are then made with regard to how the process of making reparations for essentially irreparable loss can be eased. It is only the ongoing combination of truth, justice and survivor-support that may one day be sufficient to make some survivors feel at ease with the idea of accepting reparations as a symbolic replacement for what has been lost.